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Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types.

ABSTRACT: Literature concerning anterior cruciate ligament (ACL) reconstruction has increased in both scope and sophistication during the last decades. Heretofore, the principle focus has been on graft choice comparisons, the appropriate handling of co-injuries such as meniscal tears, cartilage lesions, as well as extra-articular ligament injuries. Despite the accumulated knowledge, there is still a lack of clarity concerning a therapy algorithm for different rupture types. With different consequences in therapy strategy, rupture types were differentiated as (1) subsynovial ACL tears/stretch injury and proximal avulsion tears, (2) single-bundle tear (anteromedial/posterolateral), and (3) total ACL rupture. The article presented here provides an overview of recommended operative therapy strategies for different rupture types of the ACL. Within the past decade, advances in arthroscopic technology coupled with rigorous scientific inquiry have resulted in significantly improved treatment options. With these developments in mind, ACL surgery and postoperative therapy can and should be performed in a manner befitting the patient's individual circumstances. Furthermore, intra- and postoperative suggestions including vancomycin graft-coating, as well as an accelerated "Early Active Rehabilitation" program, including early active physiotherapy without postoperative bracing, as well as additional postoperative extracorporeal shock-wave therapy are recommended.

SUBMITTER: Patrick W

PROVIDER: S-EPMC7372522 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundLateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion in daily life.Purpose/hypothesisThe primary aim of the present study was to identify kinematic differences during the execution of an activity under weightbearing conditions between knees having undergone ACLR using anatomic single-bundle (SB) versus single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was to compare the postoperative kinematic data with those from the same knees before ACLR and from the healthy contralateral knees in order to investigate if ACLR was able to restore physiologic knee biomechanics during squat execution. The hypotheses were that (1) the SBLP technique would allow a better restoration of internal-external (IE) knee rotation than would SB and (2) regardless of the technique, ACLR would not fully restore physiologic knee biomechanics.Study designRandomized controlled trial; Level of evidence, 2.MethodsIn total, 32 patients (42 knees) were included in the study. Patients were asked to perform a single-leg squat before surgery (ACL-injured group, n = 32; healthy contralateral group, n = 10) and at minimum 18-month follow-up after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined using a validated model-based tracking process that matched patient-specific magnetic resonance imaging bone models to dynamic biplane radiographic images under the principles of roentgen stereophotogrammetric analysis. Data processing was performed using specific software. The authors compared IE and varus-valgus rotations and anterior-posterior and medial-lateral translations among the groups.ResultsThe mean follow-up period was 21.7 ± 4.5 months. No kinematic differences were found between the SB and SBLP groups (P > .05). A more medial tibial position (P < .05) of the ACL-injured group was reported during the entire motor task and persisted after ACLR in both the SB and the SBLP groups. Differences in IE and varus-valgus rotations were found between the ACL-injured and healthy groups.ConclusionThere were no relevant kinematic differences between SBLP and anatomic SB ACLR during the execution of a single-leg squat. Regardless of the surgical technique, ACLR failed in restoring knee biomechanics.RegistrationNCT02323386 (ClinicalTrials.gov identifier).

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Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types.

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